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The Affordable Care Act and the Future of Nursing

Madison Krekow
California State University, Stanislaus


















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The Affordable Care Act and the Future of Nursing
America has entered a new era in healthcare which focuses on the premise of care for all
citizens regardless of economic status. This new system of health is due to the implementation of
the Affordable Care Act (ACA), whose goal is to provide healthcare services to all people and
transition American healthcare from a treatment system to a preventative system (Hawks, 2012).
The job of the healthcare worker, particularly for nurses, will change dramatically as the ACA is
implemented. The changes within the nursing profession will create a need for new nurses in
order to accommodate the nurses ever-expanding role within this novel healthcare system. The
Institute of Medicine (IOM) addresses the changes that are occurring in nursing practice in their
report The Future of Nursing: Leading change, Advancing Health (2010). Within the report
recommendations for the nursing profession are made to encourage a smooth transition to this
new healthcare system.
The IOM report The Future of Nursing: Leading change, Advancing Health (2010), will
be a helpful tool to guide nursing into the new era of the ACA. The study was written in order to
investigate possible barriers that the nursing profession would face and proposed possible ways
for nurses to lead and advance the healthcare system. After conducting their study, the IOM
developed four key messages and eight recommendations in order for the nursing profession to
thrive in the new healthcare system. The study found that all parts of the healthcare field
including policy makers, government officials, healthcare executives, and healthcare
professionals must participate and take note of the IOM recommendations in order to advance
the healthcare field (IOM, 2010). The IOM did not create this report single-handedly, and other
organizations contributed financially to the creation of this report.
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Two organizations funded and were the key players in the IOM report on the future of
nursing (Harris, 2014). The IOM contributed financially to the study along with the help of the
Robert Wood Johnson Foundation (RWJF). The IOM is a nonprofit organization founded in
1970 whose purpose is to serve as an advisory board on the overall health of the American
people. The RWJF is a privately funded non-profit organization whose focus is on philanthropic
efforts within the United States. Both the IOM and the RWJF focus primarily on the public
health of the United States so they inherently have an interest on how nursing will be affected by
the implementation of the ACA. Together, the IOM and the RWJF formed a task force in 2008
called The Committee for the RWJF Initiative on the Future of Nursing. This committee made up
of the IOM and RWJF created a report with recommendations to the nursing practice as a whole
that will create a nursing force who can participate as leaders in Americas new healthcare
system (Harris, 2014).
Upon concluding their study on the effects of the ACA on the nursing workforce, the
IOM presented 4 key messages to American nurses. These messages focus not just on nursing
practice but also speak to nursing education and nurse leaders (Harris, 2014). The first message
states, nurses should practice to the full extent of their education and training (IOM, 2010,
p.2). This message especially applies to advanced practice nurses (APNs) who are highly trained
but due to restrictions and laws, practice is limited depending on the laws of any particular state.
The report recommends that APNs practice is standardized at the state and federal level so that
all states have the same practice standards that would not prevent APNs from practicing to the
full extent of their education. The second message within the IOM report states, nurses should
achieve higher levels of education through an improved education system that promotes seamless
academic progression (IOM, 2010, p.2). The goal of this message is to increase the quality of
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care provided at the acute and community level while simultaneously increasing the number of
advanced practice nurses, nurse researchers, and nursing educators (IOM, 2010). The third
message within the IOM report states, Nurses should be full partners, with physicians and other
health care professionals, in redesigning health care in the United States (IOM, 2010, p.3).
Nurses must participate as leaders during the redesign of health care as policy makers, board
room executives, and within the community and acute care setting. The views that nurses have of
their role in policy making must change and they must view themselves as people who create and
change policy in this new healthcare system. The fourth message the IOM gives to nursing
practice states, Effective workforce planning and policy making require better data collection
and an improved information infrastructure (IOM, 2010, p.3). In order to plan for the changes
that will accompany the ACA data needs to be collected so that changes will reflect the current
status of all healthcare professions. The data will tell us how we will meet our new workforce
needs that will arise as our care system expands to meet the needs of a larger patient base. Within
the four messages the IOM gives to the nursing profession they make eight recommendations
that will help the profession adapt to their larger role within ACA.
The recommendations made by the 2010 IOM study will aid the nursing profession in
addressing the four key messages provided. The first recommendation is to remove scope of
practice barriers that prevent APN from practicing to the full extent of their education (IOM,
2010). By doing this, there will be more available and cost-effective primary care providers in
the form of APN (Clearly &Wilmoth, 2010). The second recommendation is that nurses should
be provided with increasing opportunities to lead and collaborate within improvement process
that will accompany the ACA (IOM, 2010). With nurses in a leadership role, patient-centered
care models can be developed to improve patient outcomes and decrease healthcare costs
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(Clearly & Wilmoth, 2010). Another recommendation is to implement nurse residency programs
which will improve nurse retention and competency levels of nurses in all levels of practice
(IOM, 2010). The fourth recommendation is to increase the level of baccalaureate prepared
nurses to 80% which will increase nurse competency, and allow for a seamless transition to high
educational levels in an effort to create more APNs (IOM, 2010). Doubling the number of
doctorate nurses within ten years is the fifth recommendation made by the IOM. Not only will
this increase the number of APNs functioning as primary care providers but this will also provide
more nurse leaders, researchers, and educators (IOM, 2010). Lifelong learning for all nurses is
the sixth recommendation and this will ensure that evidence-based practice will be at the center
of care indefinitely for the American people. The seventh recommendation is to prepare nurses to
be leaders of change in advancing health. This can be accomplished by encouraging nurse
representation on boards of healthcare organizations, and those institutions that influence the
delivery of healthcare. Lastly, the eight recommendation is to build a system for the collection of
healthcare workforce data in order to quickly identify areas of need within the nursing field
(IOM, 2010). With the four messages, and the eight recommendations from the IOM report, the
nursing profession has the chance to evolve greatly.
As the ACA is implemented and as the IOM report recommendations are set in place, the
role of the nurse will expand greatly in the United States. Community based nursing will expand
greatly as preventative healthcare takes center stage, higher levels of education will be standard
practice, and nurses leaders will be at the forefront of policy change within government at the
state and federal level. Student nurses can participate in this change through striving for the
greatest amount of education they can receive, by joining professional nursing organizations, by
participating in nursing research, and by working in nursing residency programs upon
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graduation. The American healthcare system will be positively affected by the implementation of
the ACA through lowered healthcare costs and an increase in population health that comes with
preventative medicine. There will be an increase in the number of nurses through newly funded
educational grants with incentives for nurses to achieve higher levels of education. Access to
healthcare will improve as APNs are allowed to practice to the full extent of their education
which will aid in lowering the cost of care and improving the continuity of primary care
(Wakefield, 2010).
The American healthcare system is in a historical and exciting period of change that
presents an excellent opportunity for the nursing profession. The demand for advanced practice
and bachelor prepared nurses puts nursing at the forefront of the ACA with opportunities for
leadership positions. With the IOM report The Future of Nursing: Leading Change, Advancing
Health (2010), nurses have all the tools they need to succeed in this new healthcare system.
Highly quality, low cost, and community-based care under the ACA will be driven by a group
highly educated nurse leaders. For nursing, it is a very exciting time indeed.









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References
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nursing. Tar Heel Nurse, April-June, 8-12. Retrieved from http://www.ncbi.nlm.nih.gov.
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Harris, E. (2014). The future of nursing: Eight recommendations in review [Lecuture]. Retrieved
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Hawks, J. H. (2012). The affordable care act: Emphasis on population health. Urologic Nursing,
32(5), 233-234. Retrieved from http://www.ncbi.nlm.nih.gov.ezproxy.lib.csustan.edu
Insitute of Medicine [IOM]. (2010). The Future of Nursing: Leading Change, Advancing Health.
Retrieved from http://www.iom.edu/Reports/2010/The-future-of-nursing-leading-change-
advancing-health.aspx
Wakefield, M. K. (2010). Nurses and the affordable care act: New legislation gives nurses a
greater voice. American Journal of Nursing, 110(9), 11. Retrieved from
http://www.ncbi.nlm.nih.gov. ezproxy.lib.csustan.edu